The adherence gap: Rural dwelling, low level of education, and missed opportunities for optimal hepatitis B control

Abstract

Background and Objectives: Long-term antiviral use can suppress hepatitis B virus (HBV) DNA, normalize liver function tests, reverse fibrosis and cirrhosis, and improve histological changes. Understanding adherence and the factors affecting it is crucial for managing chronic hepatitis B virus (CHB) patients, achieving sustained suppression with low drug resistance risk, and developing strategies to address poor adherence. This study aims to assess antiviral medication adherence and factors associated with adherence among HBV patients on treatment at the gastroenterology clinic in Tikur Anbessa Specialized Hospital (TASH). Methods: A cross-sectional study was conducted in 149 HBV patients undergoing therapy at TASH from May 2023 to February 2024. The medication adherence level was assessed using Morisky’s 8-item medication adherence questionnaire. Data was entered into Epi Info 7 for database construction and exported to SPSS version 26. Different statistical analyses were used, including frequencies of variables and descriptive statistics. An ordinal logistic regression analysis was used to identify factors associated with medication adherence levels. The proportional odds model (POM) assumptions were checked using chi-square and parallel line tests. Results: The study found that only 32.2% participants had high adherence, 39.6% had medium adherence, and 28.2% had low adherence. Rural dweller (a POR: 2.4; 95%CI: 1.09 to 5.20), low educational level (a POR: 3; 95%CI: 1.27 to 7.13), being unmarried (a POR: 2.52; 95%CI: 1.15 to 5.50), not being counseled about medication adherence by treating physicians (a POR: 3.2; 95%CI: 1.61 to 6.50), and an abnormal liver function tests (a POR: 2.31; 95%CI: 1.08 to 4.92) were significantly associated with medium or low medication adherence level. Conclusion: The study reveals low medication adherence rates among participants, with only a minority demonstrating high adherence. Factors such as rural dwellings, low educational level, being unmarried, lack of counseling, and abnormal liver function tests were significantly associated with medium or low adherence. Targeted interventions are needed to improve adherence, especially for individuals in rural areas with lower education levels and who are unmarried. Efforts should be made to integrate medication adherence discussions into routine healthcare visits and raise physician awareness about counseling patients on adherence are crucial.